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Dyspnoea
Types
Differential Diagnoses
Increased Demand
- Physiological
- exercise
- pregnancy
- high altitude
- Pathological
- psychogenic
- anaemia
- acidosis
- increased metabolism
- fever
- sepsis
- hyperthyroidism
- hypovolaemia
Impaired performance
- air flow limitation
- asthma
- bronchitis
- emphysema
- large airway obstruction
- reduced lung volume
- impaired gas exchange / loss of lung compliance
- consolidation
- oedema
- atelectasis / collapse
- fibrosis
- thoracic cage compliance
- neuromuscular failure
- central depression
- myoneuropath
Respiratory
Acute
Subacute
Chronic
Cardiovascular
Other
History
- How breathless
- precipitants
- house dust mite
- allergy
- cold
- cough / sputum
- wheeze
- chest
pain
- haemoptysis
- onset
- general symptoms
- weight loss
- fevers / sweat
- systems review
- past medical history
- smoking history
- occupation
- drug history
- family history
Signs
- anxiety
- wheeze in chest
- calf swelling / tenderness
Investigation
Bedside
- peak expiratory flow
- spirometry (FEV1/FVC)
- ratio normal = restrictive pattern
- ratio reduced = obstructive pattern
- oxygen saturation - rest / exercise
- sputum - microscopy and culture
Further Investigation
- 2 weeks of home peak flow measurements
- full pulmonary function tests
- ventilation / perfusion scan
- spiral CT pulmonary angiogram
Follow on
- reassure patient they don't have cancer
- narrow down differential diagnosis
- base treatment on result
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